Provider Demographics
NPI:1710209408
Name:PROANO, DIEGO FERNADO (DC)
Entity Type:Individual
Prefix:
First Name:DIEGO
Middle Name:FERNADO
Last Name:PROANO
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:934 S EAST AVE
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21224-5032
Mailing Address - Country:US
Mailing Address - Phone:240-426-3076
Mailing Address - Fax:
Practice Address - Street 1:6101 EXECUTIVE BLVD STE 280
Practice Address - Street 2:
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20852-3910
Practice Address - Country:US
Practice Address - Phone:301-231-0050
Practice Address - Fax:301-231-6056
Is Sole Proprietor?:No
Enumeration Date:2010-02-22
Last Update Date:2020-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDS03611111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor